{"id":27289,"date":"2020-05-13T12:53:14","date_gmt":"2020-05-13T12:53:14","guid":{"rendered":"https:\/\/dev.mtelehealth.com\/?p=27289"},"modified":"2020-05-13T12:53:14","modified_gmt":"2020-05-13T12:53:14","slug":"cms-flexibilities-to-fight-covid-19-inpatient-rehabilitation-facilities","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/cms-flexibilities-to-fight-covid-19-inpatient-rehabilitation-facilities\/","title":{"rendered":"CMS Flexibilities to Fight COVID-19 – Inpatient Rehabilitation Facilities"},"content":{"rendered":"\n

<\/a>Download PDF<\/a><\/div>\n\n\n\n


4\/29\/2020<\/p>\n\n\n\n

Inpatient Rehabilitation Facilities: CMS Flexibilities to Fight COVID-19<\/strong><\/p>\n\n\n\n

Since the beginning of the COVID-19 Public Health Emergency, the Trump Administration has issued an<\/p>\n\n\n\n

unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare<\/p>\n\n\n\n

system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. These<\/p>\n\n\n\n

temporary changes will apply immediately across the entire U.S. healthcare system for the duration of<\/p>\n\n\n\n

the emergency declaration. The goals of these actions are to 1) expand the healthcare system workforce<\/p>\n\n\n\n

by removing barriers for physicians, nurses, and other clinicians to be readily hired from the community<\/p>\n\n\n\n

or from other states; 2) ensure that local hospitals and health systems have the capacity to handle a<\/p>\n\n\n\n

potential surge of COVID-19 patients through temporary expansion sites (also known as CMS Hospital<\/p>\n\n\n\n

Without Walls); 3) increase access to telehealth in Medicare to ensure patients have access to physicians<\/p>\n\n\n\n

and other clinicians while keeping patients safe at home; 4) expand in-place testing to allow for more<\/p>\n\n\n\n

testing at home or in community based settings; and 5) put Patients Over Paperwork to give temporary<\/p>\n\n\n\n

relief from many paperwork, reporting and audit requirements so providers, health care facilities,<\/p>\n\n\n\n

Medicare Advantage and Part D plans, and States can focus on providing needed care to Medicare and<\/p>\n\n\n\n

Medicaid beneficiaries affected by COVID-19.<\/p>\n\n\n\n

Medicare Telehealth<\/em><\/strong><\/p>\n\n\n\n

\u2022 Telehealth may be used to fulfill the requirement for physicians to conduct the required face-toface<\/p>\n\n\n\n

visits at least 3 days a week for the duration of a Medicare Part A fee-for-service patient\u2019s stay<\/p>\n\n\n\n

in an inpatient rehabilitation facility.<\/p>\n\n\n\n

Patients Over Paperwork<\/em><\/strong><\/p>\n\n\n\n

\u2022 \u201cStark Law\u201d Waivers: <\/em>The physician self-referral law (also known as the \u201cStark Law\u201d) prohibits<\/p>\n\n\n\n

a physician from making referrals for certain healthcare services payable by Medicare if the<\/p>\n\n\n\n

physician (or an immediate family member) has a financial relationship with the entity performing<\/p>\n\n\n\n

the service. There are statutory and regulatory exceptions, but in short, a physician cannot refer<\/p>\n\n\n\n

a patient to any entity with which he or she has a financial relationship. On March 30, 2020, CMS<\/p>\n\n\n\n

issued blanket waivers of certain provisions of the Stark Law regulations. These blanket waivers<\/p>\n\n\n\n

apply to financial relationships and referrals that are related to the COVID-19 emergency. The<\/p>\n\n\n\n

remuneration and referrals described in the blanket waivers must be solely related to COVID-19<\/p>\n\n\n\n

Purposes, as defined in the blanket waiver document. Under the waivers, CMS will permit certain<\/p>\n\n\n\n

referrals and the submission of related claims that would otherwise violate the Stark Law. These<\/p>\n\n\n\n

flexibilities include:<\/p>\n\n\n\n

o Hospitals and other health care providers can pay above or below fair market value for<\/p>\n\n\n\n

the personal services of a physician (or an immediate family member of a physician), and<\/p>\n\n\n\n

parties may pay below fair market value to rent equipment or purchase items or services.<\/p>\n\n\n\n

For example, a physician practice may be willing to rent or sell needed equipment to a<\/p>\n\n\n\n

hospital at a price that is below what the practice could charge another party. Or, a hospital<\/p>\n\n\n\n

may provide space on hospital grounds at no charge to a physician who is willing to treat<\/p>\n\n\n\n

patients who seek care at the hospital but are not appropriate for emergency department or<\/p>\n\n\n\n

inpatient care.<\/p>\n\n\n\n

o Health care providers can support each other financially to ensure continuity of health care<\/p>\n\n\n\n

operations. For example, a physician owner of a hospital may make a personal loan to the<\/p>\n\n\n\n

hospital without charging interest at a fair market rate so that the hospital can make payroll<\/p>\n\n\n\n

or pay its vendors.<\/p>\n\n\n\n

4\/29\/2020<\/p>\n\n\n\n

2<\/p>\n\n\n\n

o Hospitals can provide benefits to their medical staffs, such as multiple daily meals, laundry<\/p>\n\n\n\n

service to launder soiled personal clothing, or child care services while the physicians are at<\/p>\n\n\n\n

the hospital and engaging in activities that benefit the hospital and its patients.<\/p>\n\n\n\n

o Health care providers may offer certain items and services that are solely related to<\/p>\n\n\n\n

COVID-19 Purposes (as defined in the waivers), even when the provision of the items or<\/p>\n\n\n\n

services would exceed the annual non-monetary compensation cap. For example, a home<\/p>\n\n\n\n

health agency may provide continuing medical education to physicians in the community<\/p>\n\n\n\n

on the latest care protocols for homebound patients with COVID-19, or a hospital may<\/p>\n\n\n\n

provide isolation shelter or meals to the family of a physician who was exposed to the novel<\/p>\n\n\n\n

coronavirus while working in the hospital\u2019s emergency department.<\/p>\n\n\n\n

o Physician-owned hospitals can temporarily increase the number of their licensed beds,<\/p>\n\n\n\n

operating rooms, and procedure rooms, even though such expansion would otherwise be<\/p>\n\n\n\n

prohibited under the Stark Law. For example, a physician-owned hospital may temporarily<\/p>\n\n\n\n

convert observation beds to inpatient beds to accommodate patient surge during the<\/p>\n\n\n\n

COVID-19 pandemic in the United States.<\/p>\n\n\n\n

o Some of the restrictions regarding when a group practice can furnish medically necessary<\/p>\n\n\n\n

designated health services (DHS) in a patient\u2019s home are loosened. For example, any<\/p>\n\n\n\n

physician in the group may order medically necessary DHS that is furnished to a patient by<\/p>\n\n\n\n

one of the group\u2019s technicians or nurses in the patient\u2019s home contemporaneously with a<\/p>\n\n\n\n

physician service that is furnished via telehealth by the physician who ordered the DHS.<\/p>\n\n\n\n

o Group practices can furnish medically necessary MRIs, CT scans or clinical laboratory services<\/p>\n\n\n\n

from locations like mobile vans in parking lots that the group practice rents on a part-time<\/p>\n\n\n\n

basis.<\/p>\n\n\n\n

\u2022 Intensity of Therapy Requirement (\u201c3-Hour Rule\u201d): <\/em>The Coronavirus Aid, Relief, and<\/p>\n\n\n\n

Economic Security (CARES) Act requires the Secretary to waive \u00a7 412.622(a)(3)(ii)<\/p>\n\n\n\n

(commonly referred to as the \u201c3-hour rule\u201d), the criterion that patients treated in inpatient<\/p>\n\n\n\n

rehabilitation facilities generally receive at least 15 hours of therapy per week. The waiver<\/p>\n\n\n\n

of this requirement for all beneficiaries treated in a hospital-based or freestanding IRF<\/p>\n\n\n\n

provides flexibility for IRFs to provide care for patients during the PHE for the COVID-19<\/p>\n\n\n\n

pandemic. IRFs should strive to provide typical IRF levels of care for beneficiaries admitted<\/p>\n\n\n\n

during the COVID-19 crisis who require and can benefit from the IRF levels of care.<\/p>\n\n\n\n

\u2022 Standards to Rehabilitate Patients: <\/em>Medicare payment regulations require IRFs to meet certain<\/p>\n\n\n\n

standards to rehabilitate patients, including ensuring that admitted patients are stable enough<\/p>\n\n\n\n

for rehabilitation therapy, need at least two types of therapy, and develop plans of care. During<\/p>\n\n\n\n

the PHE, these standards do not have to apply to patients who are admitted to freestanding IRFs<\/p>\n\n\n\n

solely for surge capacity reasons in a state that is currently in Phase 1 or has not yet entered Phase<\/p>\n\n\n\n

1 of the White House\u2019s Guidelines for Opening Up America Again, but would continue to apply<\/p>\n\n\n\n

to patients who are admitted for the IRFs\u2019 standard rehabilitative services. We anticipate that<\/p>\n\n\n\n

freestanding IRFs will take advantage of these flexibilities for some of their beneficiaries (those<\/p>\n\n\n\n

who are surge patients from inpatient hospitals), while continuing to provide standard IRF-level<\/p>\n\n\n\n

care for those beneficiaries who would benefit from IRF-level care and would otherwise receive<\/p>\n\n\n\n

such care in the absence of the PHE.<\/p>\n\n\n\n

\u2022 IRF Teaching Status Adjustment Payments: <\/em>To ensure that teaching IRFs can alleviate bed capacity<\/p>\n\n\n\n

issues by taking patients from the inpatient acute care hospitals without being penalized by lower<\/p>\n\n\n\n

teaching status adjustments, we are freezing the IRFs\u2019 teaching status adjustment payments at<\/p>\n\n\n\n

4\/29\/2020<\/p>\n\n\n\n

3<\/p>\n\n\n\n

their values prior to the PHE. For the duration of the COVID-19 PHE, an IRF\u2019s teaching status<\/p>\n\n\n\n

adjustment payments will be the same as they were on the day before the COVID-19 PHE was<\/p>\n\n\n\n

declared.<\/p>\n\n\n\n

\u2022 IRF Quality Reporting Program<\/em>: We are delaying the compliance dates for collecting and<\/p>\n\n\n\n

reporting of the Transfer of Health Information quality measures and certain standardized patient<\/p>\n\n\n\n

assessment data elements (SPADEs) adopted for the IRF Quality Reporting Program. IRFs will<\/p>\n\n\n\n

be required to begin collecting the Transfer of Health Information quality measures and certain<\/p>\n\n\n\n

SPADEs on October 1st of the year that is at least one fiscal year after the end of the public health<\/p>\n\n\n\n

emergency.<\/p>\n\n\n\n

\u2022 Post Admission Evaluations<\/em>: Physicians are no longer required to conduct and document postadmission<\/p>\n\n\n\n

evaluations for Medicare patients admitted to an IRF during the PHE. The postadmission<\/p>\n\n\n\n

evaluation covers much of the same information as continues to be included in the preadmission<\/p>\n\n\n\n

screening of the patient and the patient\u2019s plan of care. This reduction in burden gives<\/p>\n\n\n\n

more time for physicians to take care of patients.<\/p>\n\n\n\n

\u2022 Flexibility for Inpatient Rehabilitation Facilities Regarding the \u201c60 Percent Rule\u201d: <\/em>CMS is waiving<\/p>\n\n\n\n

requirements to allow IRFs to exclude patients from the IRF freestanding hospital\u2019s or unit\u2019s<\/p>\n\n\n\n

inpatient population for purposes of calculating the applicable thresholds associated with the<\/p>\n\n\n\n

requirements to receive payment as an IRF (commonly referred to as the \u201c60 percent rule\u201d) if an<\/p>\n\n\n\n

IRF admits a patient solely to respond to the emergency and the patient\u2019s medical record properly<\/p>\n\n\n\n

identifies the patient as such. In addition, during the applicable waiver time period, we would<\/p>\n\n\n\n

also apply the exception to facilities not yet classified as IRFs, but that are attempting to obtain<\/p>\n\n\n\n

classification as an IRF.<\/p>\n\n\n\n

\u2022 Freestanding IRFs are able to work with acute care hospitals under arrangements to provide surge<\/p>\n\n\n\n

capacity for the community.<\/p>\n\n\n\n

\u2022 Provider Enrollment<\/em>: CMS has established toll-free hotlines for all providers as well as the following<\/p>\n\n\n\n

flexibilities for provider enrollment:<\/p>\n\n\n\n

o Waive certain screening requirements.<\/p>\n\n\n\n

o Postpone all revalidation actions.<\/p>\n\n\n\n

o Expedite any pending or new applications from providers.<\/p>\n\n\n\n

Medicare appeals in Fee for Service, Medicare Advantage (MA) and Part D<\/strong><\/p>\n\n\n\n

\u2022 CMS is allowing Medicare Administrative Contractors (MACs) and Qualified Independent<\/p>\n\n\n\n

Contractor (QICs) in the FFS program 42 CFR 405.942 and 42 CFR 405.962 and MA and Part D<\/p>\n\n\n\n

plans, as well as the Part C and Part D Independent Review Entity (IREs), 42 CFR 562, 42 CFR<\/p>\n\n\n\n

423.562, 42 CFR 422.582 and 42 CFR 423.582 to allow extensions to file an appeal;<\/p>\n\n\n\n

\u2022 CMS is allowing MACs and QICs in the FFS program 42 CFR 405. 950 and 42 CFR 405.966 and<\/p>\n\n\n\n

the Part C and Part D IREs to waive requirements for timeliness for requests for additional<\/p>\n\n\n\n

information to adjudicate appeals; MA plans may extend the timeframe to adjudicate organization<\/p>\n\n\n\n

determinations and reconsiderations for medical items and services (but not Part B drugs) by up<\/p>\n\n\n\n

to 14 calendar days if: the enrollee requests the extension; the extension is justified and in the<\/p>\n\n\n\n

enrollee’s interest due to the need for additional medical evidence from a noncontract provider<\/p>\n\n\n\n

that may change an MA organization’s decision to deny an item or service; or, the extension is<\/p>\n\n\n\n

justified due to extraordinary, exigent, or other non-routine circumstances and is in the enrollee’s<\/p>\n\n\n\n

interest 42 CFR \u00a7 422.568(b)(1)(i), \u00a7 422.572(b)(1) and \u00a7 422.590(f)(1);<\/p>\n\n\n\n

4\/29\/2020<\/p>\n\n\n\n

4<\/p>\n\n\n\n

\u2022 CMS is allowing MACs and QICs in the FFS program 42 C.F.R 405.910 and MA and Part D plans,<\/p>\n\n\n\n

as well as the Part C and Part D IREs to process an appeal even with incomplete Appointment of<\/p>\n\n\n\n

Representation forms 42 CFR \u00a7 422.561, 42 CFR \u00a7 423.560. However, any communications will only<\/p>\n\n\n\n

be sent to the beneficiary;<\/p>\n\n\n\n

\u2022 CMS is allowing MACs and QICs in the FFS program 42 CFR 405. 950 and 42 CFR 405.966 and<\/p>\n\n\n\n

MA and Part D plans, as well as the Part C and Part D IREs to process requests for appeal that<\/p>\n\n\n\n

don\u2019t meet the required elements using information that is available 42 CFR \u00a7 422.562, 42 CFR \u00a7<\/p>\n\n\n\n

423.562.<\/p>\n\n\n\n

\u2022 CMS is allowing MACs and QICs in the FFS program 42 CFR 405. 950 and 42 CFR 405.966 and MA<\/p>\n\n\n\n

and Part D plans, as well as the Part C and Part D IREs, 42 CFR 422.562, 42 CFR 423.562 to utilize all<\/p>\n\n\n\n

flexibilities available in the appeal process as if good cause requirements are satisfied.<\/p>\n\n\n\n

Cost Reporting<\/em><\/strong><\/p>\n\n\n\n

\u2022 CMS is delaying the filing deadline of certain cost report due dates due to the COVID-19<\/p>\n\n\n\n

outbreak. We are currently authorizing delay for the following fiscal year end (FYE) dates. CMS<\/p>\n\n\n\n

will delay the filing deadline of FYE 10\/31\/2019 cost reports due by March 31, 2020 and FYE<\/p>\n\n\n\n

11\/30\/2019 cost reports due by April 30, 2020. The extended cost report due dates for these<\/p>\n\n\n\n

October and November FYEs will be June 30, 2020. CMS will also delay the filing deadline of the<\/p>\n\n\n\n

FYE 12\/31\/2019 cost reports due by May 31, 2020. The extended cost report due date for FYE<\/p>\n\n\n\n

12\/31\/2019 will be July 31, 2020.<\/p>\n\n\n\n

\u2022 Accelerated\/Advance Payments<\/em>: In order to provide additional cash flow to healthcare providers<\/p>\n\n\n\n

and suppliers impacted by COVID-19, CMS expanded and streamlined the Accelerated and<\/p>\n\n\n\n

Advance Payments Program, which provided conditional partial payments to providers and<\/p>\n\n\n\n

suppliers to address disruptions in claims submission and\/or claims processing subject to<\/p>\n\n\n\n

applicable safeguards for fraud, waste and abuse. Under this program, CMS made successful<\/p>\n\n\n\n

payment of over $100 billion to healthcare providers and suppliers. As of April 26, 2020, CMS<\/p>\n\n\n\n

is reevaluating all pending and new applications for the Accelerated Payment Program and has<\/p>\n\n\n\n

suspended the Advance Payment Program, in light of direct payments made available through the<\/p>\n\n\n\n

Department of Health & Human Services\u2019 (HHS) Provider Relief Fund. Distributions made through<\/p>\n\n\n\n

the Provider Relief Fund do not need to be repaid. For providers and suppliers who have received<\/p>\n\n\n\n

accelerated or advance payments related to the COVID-19 Public Health Emergency, CMS will not<\/p>\n\n\n\n

pursue recovery of these payments until 120 days after the date of payment issuance. Providers<\/p>\n\n\n\n

and suppliers with questions regarding the repayment of their accelerated or advance payment(s)<\/p>\n\n\n\n

should contact their appropriate Medicare Administrative Contractor (MAC).<\/p>\n\n\n\n

Additional Information<\/em><\/strong><\/p>\n\n\n\n

\u2022 The Interim Final Rules can be found at: https:\/\/www.cms.gov\/about-cms\/emergencypreparedness-<\/p>\n\n\n\n

response-operations\/current-emergencies\/coronavirus-waivers .<\/p>\n\n\n\n

\u2022 CMS has released guidance to providers related to relaxed reporting requirements for quality<\/p>\n\n\n\n

reporting programs at https:\/\/www.cms.gov\/files\/document\/guidance-memo-exceptions-andextensions-<\/p>\n\n\n\n

quality-reporting-and-value-based-purchasing-programs.pdf.<\/p>\n\n\n","protected":false},"excerpt":{"rendered":"

4\/29\/2020 Inpatient Rehabilitation Facilities: CMS Flexibilities to Fight COVID-19 Since the beginning of the COVID-19 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_uag_custom_page_level_css":"","_uf_show_specific_survey":0,"_uf_disable_surveys":false,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[61,14,186,242,189,141,159],"tags":[],"class_list":["post-27289","post","type-post","status-publish","format-standard","hentry","category-atouchaway","category-blog","category-medicare","category-cms-flexibilities-to-fight-covid-19","category-covid-19-coronavirus","category-reimbursement","category-telehealth"],"acf":[],"yoast_head":"\nCMS Flexibilities to Fight COVID-19 - Inpatient Rehabilitation Facilities · Dr. Miltie, LLC - At-Home Testing<\/title>\n<meta name=\"description\" content=\"Download PDF 4\/29\/2020 Inpatient Rehabilitation Facilities: CMS Flexibilities to Fight COVID-19 Since the beginning of the COVID-19 Public Health\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link 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